Outcome of pediatric renal transplants in a developing country

Abstract

This study was conducted to evaluate the outcome of pediatric renal transplants at our center. A retrospective analysis was done on 39 pediatric transplants (age at transplant <18 years) done at our center over the last 10 years. The mean age at transplant was 15.6+/-1 years (10-17 years). They comprised 4.2% of all renal transplants done at our center (39/921) over the period. Girls comprised 17.5% of total recipients ( n=7). Two patients had a preemptive transplant. The underlying causes of end stage renal disease were chronic glomerulonephritis ( n=21), chronic interstitial nephritis ( n=17) and Alport syndrome [1]. All the 39 children were initiated on triple drug immunosuppression (cyclosporin A (CsA) azathioprine, prednisolone). All patients received grafts from living related donors. In the first month, three patients had graft loss (serum creatinine, SCr, >5 mg/dl). Of these, two patients died because of septicemia and one had acute cortical necrosis. There was evidence of infection in 16 patients (40%). Acute rejection was seen in 17 patients (45.8%). The 1-year patient and graft survival was 89% and at 3 years 70%. The actuarial graft survival at 5 years was 50%. Twelve children discontinued CsA after 1 year post-transplant and five of these had graft loss. Graft losses were significantly greater in patients who discontinued CsA as compared to those who continued CsA (5/12 vs 2/22). After a mean follow-up of 31.5+/-3.5 months, of the 37 patients, 10 had graft loss and chronic graft dysfunction was observed in another 9 patients. The rest of the 17 (48%) patients had a mean SCr of 1.2 mg/dl. The long-term outcome of pediatric renal transplants in our country remains suboptimal. CsA discontinuation due to financial constraints and/or non-compliance remain the most important reasons for this.

Report of an NIH task force on research priorities in chronic kidney disease in children

“…Children with CKD should be studied independent of etiology-whether disease is congenital or acquired [130,131]. Those at risk for congenital disease or with prenatal diagnoses should be incorporated into a separate extension of this study that examines specific factors important for post-natal development in those born at risk for kidney disease.…”

Long‐term outcome of deceased donor renal transplantation in pediatric recipients: A single‐center experience from a developing country

“…In a study by Gulati et al. (20) from Delhi, the actuarial graft survival at five yr was 50%. CsA discontinuation owing to financial constraints and/or non‐compliance remains the most important reasons for suboptimal outcome in this study.…”

Outcome and complications of living donor pediatric renal transplantation: Experience from a tertiary care center

“…[5] Chronic graft dysfuncton was defined as persistently raised serum creatinine to 2 mg/dL or more for more than 3 months. [6] Graft loss was defined as the need for nephrectomy, persistent rise of serum creatinine to 5 mg/dL or more, or patient death with a functioning graft. [6] Graft rejection was diagnosed based on clinical suspicion aided with graft Doppler study and confirmed with graft biopsy.…”

“…[6] Graft loss was defined as the need for nephrectomy, persistent rise of serum creatinine to 5 mg/dL or more, or patient death with a functioning graft. [6] Graft rejection was diagnosed based on clinical suspicion aided with graft Doppler study and confirmed with graft biopsy. Calcineurin inhibitor toxicity was excluded in all patients suspected to have graft rejection by serum level estimation and biopsy.…”